Supplements for melasma

What is the summary?

• Polypodium is one of the most studied supplements
• Melatonin can reduce pigmentation production
• Glutathione capsules can lighten skin 
• VItamin C tablets can be useful if serums fail
• Vitamin B3 supplements can be beneficial for skin health
• Supplements are adjunctive to medical therapy
• Supplementation can be initiated early in therapy 
• Melasma supplements can also be considered in resistant melasma

How to understand the value of supplements & melasma

Put simply, melasma supplements can be initiated in 3 ways-

Method one: fluffy treatments. If you are into holistic & natural skin care, supplements can be useful. This is ideal for patients who seek ‘alternative’ skincare, who want to avoid medical -science based therapies. This group of patients don’t fare so well when it comes to efficacy as expressed by a percentage reduction of pigment. If you are into fairy or natural treatments for melasma, you are reading the wrong website.

Method two: adjunctive to medical therapies & lasers/peels. Supplements can be initiated early in the course of melasma therapy. Our dermatologist may allocate you a customized supplement routine based upon your speed of treatment; namely if you are in a hurry to treat melasma. The downside about this method is that we employ many other combinations that may increase the complexity of the treatment (not for us, but for patients to understand & follow), acknowledging that if you can take tablets, it is a relatively straightforward adjunct. 

Method three: ‘the kitchen sink’, this is when all medical therapies fail (about 15-20% of melasma cases). This includes dermal melasma & resistant melasma. Supplementation can be initiated as one of the last ditch efforts for these patients. 

Initiation of supplementation is at the discretion of your clinician, we take into account clinical features, patient motivation & understanding of melasma.  

What is melatonin & does it work for melasma?

Melatonin is a naturally produced hormone, primarily responsible for regulating the body’s sleep-wake cycle, also known as the circadian rhythm. It can also be found in foods like tart cherries, grapes, & tomatoes. Melatonin production increases during the night in response to darkness, aiding in promoting sleep.

Besides its role in sleep regulation, melatonin has been researched for its antioxidant properties & potential benefits for skin health, including the treatment of pigmentation disorders like melasma. Clinical studies have shown that taking 3-5 mg of melatonin orally at night can significantly reduce the Melasma Area Severity Index (MASI) score. When combined with medical therapies, melatonin has been found to enhance treatment outcomes for melasma.

What is polypodium & is it effective for melasma?

Polypodium leucotomos extract (PLE) has drawn attention as a potential treatment for melasma due to its antioxidant & photoprotective properties. Its efficacy has been supported by several studies:

Antioxidant Benefits: Polypodium reduces oxidative stress, a key factor in melasma, by neutralizing free radicals and minimizing inflammation caused by UV-induced skin damage.

Clinical Research: A study in The Journal of Clinical and Aesthetic Dermatology showed that patients using polypodium orally in combination with topical sunscreens had a marked improvement in melasma lesions, with a decrease in pigmentation intensity.

Photoprotection: PLE has photoprotective properties that help absorb UV radiation and shield the skin from UV-induced damage. Research in Photodermatology, Photoimmunology & Photomedicine demonstrated that polypodium supplementation enhanced the skin’s defenses against UV radiation, thereby reducing hyperpigmentation in melasma patients.

Combination Treatments: Polypodium has shown enhanced effectiveness when used with other treatments such as topical hydroquinone, sunscreen, or laser therapies. A study in the International Journal of Dermatology revealed that oral PLE, combined with sunscreen, resulted in a greater reduction in melasma severity compared to sunscreen alone.

The typical oral dosage of polypodium leucotomos is 480 mg, taken twice daily.

What is glutathione & how good is it for melasma pigmentation?

Glutathione has been explored as a treatment for melasma due to its antioxidant and skin-lightening properties. Several studies suggest that oral glutathione can reduce melanin production, thus improving hyperpigmentation. A double-blind, randomized controlled trial published in Clinical, Cosmetic and Investigational Dermatology demonstrated that oral glutathione (500 mg daily) taken for 8-12 weeks showed some improvement in melasma severity compared to placebo.

However, results vary, and more research is needed to establish its long-term safety and efficacy for melasma treatment. The recommended dose for oral use is typically around 500-1000 mg per day.

How good are vitamin C tablets for melasma?

The role of vitamin C (ascorbic acid) serums are established & mainstream in the management of melasma pigment. This is covered in previous posts.

Oral vitamin C supplementation has been studied by Hayakawa et al. This group investigated the role of oral vitamins C and E, both alone and in combination, in patients with melasma. The combination group had the most significant response, but all experienced significant reductions in skin luminosity differences between hyperpigmented and normal skin areas.Similarly, Handog et al found oral combination therapy with vitamins A, C, E, and procyanidin effective for treating Filipino women with melasma.

The dose of oral vitamin C ranges between 500 mg once to twice daily, with a maximum of 2000 mg daily. In our option, vitamin C is best employed as at serum formulation (15% L-ascorbic acid + ferulic acid), in addition to oral supplementation.

What about vitamin B3 supplements & melasma?

Vitamin B3 has been shown to help skin health, the studies on melasma are limited, however a large trial (Chen, 2017) demonstrated that vitamin B3 (nicotinamide) is an effective and low-risk treatment for non-melanoma skin cancers. At a dosage of 500 mg twice daily for one year, it reduced the occurrence of new skin cancers by 23%. Basal cell carcinomas decreased by 20%, with a greater effect on superficial forms. Squamous cell carcinomas dropped by 30%. 

A landmark study by my colleague, Dr Devita Surjana (Cutis Dermatology) in 2012 showed at a dose of 500mg twice daily, nicotinamide has been shown to reduce solar keratoses by about 35% following two months of treatment. A lower dose of 500mg once daily is also effective, resulting in a 29% reduction after 4 months of treatment. 

Tips: if you are prone to skin cancer, consider vitamin B3. In the context of melasma, there are better alternatives. This applies to topical treatments such as niacinamide. 

How long does it take for supplements to work?

Pigment reduction takes between 4 to 12 weeks, especially when it comes to supplementation. The time delay is due to the reduction of oxidative stress & pigment reduction internally. 

Adjunctive skin care ingredients such as glycolic acid, arbutin, azelaic acid, kojic acid, thiamidol & vitamin C can speed up pigment clearance. The fastest results are seen with novel chemical peels & pico lasers for melasma.

What is an example of a skin care routine using supplements for treating melasma?

A simple melasma skincare routine is as follows: 

AM: Ascorbic acid- vitamin C, SPF, polypodium 480 mg, vitamin C tablet orally

Midday: Sunscreen reapplication, lotion, stick or spray, polypodium 480 mg

PM: 20% Azelaic acid, melatonin 3-5 mg taken nightly, option for glutathione tablets 

The combination of choice will be determined by our dermatologist at The Melasma Clinic.

Note: The greatest traction of any melasma skincare routine is the correct application of sunscreen. This has a much greater impact on melasma than any marketing objective of any skin care ingredient. Medical therapies have the next biggest impact on melasma treatment. 

Can I treat melasma with diet alone?

Knock yourself out with the following guide. Foods rich in antioxidants come from various food groups, primarily fruits, vegetables, nuts, and beverages. It probably won’t work, but a diet can reduce the incidence of heart disease, stroke & diabetes. Here’s a breakdown of antioxidant-rich foods:

Fruits

Berries (blueberries, strawberries, blackberries, raspberries) are especially high in antioxidants like vitamin C and anthocyanins.

Citrus fruits (oranges, lemons, limes) are packed with vitamin C.

Grapes(especially red and black) contain resveratrol, a potent antioxidant.

Vegetables 

Leafy greens (spinach, kale, collard greens) contain high levels of antioxidants like vitamin C and beta-carotene.

Cruciferous vegetables like broccoli, Brussels sprouts, and cauliflower have compounds like sulforaphane.

Tomatoes are a great source of lycopene, an antioxidant linked to skin health.

Nuts and Seeds

Almonds, walnuts, pecans are high in vitamin E, which acts as a powerful antioxidant.

Chia seeds provide antioxidants along with healthy omega-3 fats.

Beverages 

Green tea is rich in flavonoids.

Red wine has resveratrol, which provides antioxidant benefits in moderation.

Whole grains and Legumes

Oats and quinoa are high in antioxidants like avenanthramides.

There have been several studies investigating the role of antioxidants in skin health and their efficacy in treating conditions like melasma. For example, research by Heinrich et al. demonstrated that the long-term ingestion of high-flavanol cocoa provided significant photoprotection against UV-induced erythema, suggesting the importance of antioxidants in skin protection. Additionally, studies have shown that antioxidants like vitamins C and E, beta-carotene, and polyphenols can mitigate oxidative damage and improve skin texture, which is beneficial for treating hyperpigmentation conditions like melasma.

When do I take these supplements, before or after laser?

We initiate treatments early or later in the course of pico lasers, depending on your history (failure of previous medical therapies), clinical examination (dermal involvement initiated earlier) or your wishes of melasma resolution. 

Can supplements alone treat melasma?

Though there are controlled trials using supplements only for melasma, the best results are from combined therapies, encompassing medical therapies, sunscreen, lasers & chemical peels. 

If you are after supplements as the only way to treat melasma, see advice from a naturopathetic practitioner. We do however recommend supplements in the event of treating melasma in pregnancy. 

How long can I take supplements for?

Indefinitely. Supplements such as polypodium & ascorbic acid (vitamin C) can be taken long term. Studies have shown that antioxidants can be beneficial for health & longevity. 

What supplements can be used in melasma in pregnancy?

Vitamin C (ascorbic acid), polypodium, & melatonin can be used in pregnancy. Other safe ingredients in pregnancy include-

• Azelaic acid: 10-20%, potent anti inflammatory & pigment corrector
• Ascorbic acid: 10-20% antioxidant
• Glycolic acid: 5 to 18%, exfoliator
• Niacinamide: 5-10%, anti-inflammatory & weak pigment corrector